CPT 15835Surgery

Exc excessive skin buttock

CPT code 15835 covers the surgical removal of excess skin from the buttock area, typically performed after massive weight loss or as part of body contouring procedures. This is a reconstructive surgery that addresses functional and aesthetic concerns from redundant skin tissue.

Showing rates for

National Average

Base Medicare rate

$915.08

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

12.99

PE RVU (NF)

12.92

MP RVU

2.38

Total RVU

28.29

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document medical necessity with photographs, weight loss timeline (minimum 18 months stability), conservative treatment failures, and functional impairments (rashes, infections, mobility issues)
Impact: Proper medical necessity documentation reduces denial rate by 60-70% and is critical for non-cosmetic coverage determination
When billing bilaterally, verify payer policy on modifier 50 versus two-line billing with LT/RT modifiers, as Medicare accepts modifier 50 but some commercial payers require separate line items
Impact: Incorrect bilateral billing format can delay payment 30-45 days or result in underpayment of $457
Obtain prior authorization 30-45 days before surgery with all required documentation including BMI history, photographic evidence, and documentation of skin-related complications
Impact: Pre-authorization approval increases clean claim rate to 85%+ and prevents $915 denial
Do not unbundle 15835 with 15830 (abdominal panniculectomy) if performed during same session; use modifier 59 only if separate incisions and anatomically distinct areas
Impact: Improper unbundling triggers NCCI edits resulting in denial of $915; proper modifier 59 usage preserves both payments
For massive weight loss patients, consider staging procedures and billing separately rather than combining multiple body areas in one operative session to maximize reimbursement and reduce complications
Impact: Staged procedures may generate $915 per stage versus bundled denial risk; also improves patient safety profiles
Code assistant surgeon (modifier 80) when operative time exceeds 3 hours or patient BMI >35, as this is typically medically necessary and defensible

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 15835 in 2025?

The 2025 Medicare national average reimbursement for CPT 15835 is $915.08 for both facility and non-facility settings. This rate is based on a total RVU of 28.29 and the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic locality based on the GPCI adjustment factors.

Is CPT 15835 covered by insurance or considered cosmetic?

CPT 15835 can be covered by insurance when medically necessary, typically after massive weight loss when excess skin causes functional impairment, recurrent infections, or hygiene difficulties. Coverage requires documentation of medical necessity including weight stability for 12+ months, conservative treatment failures, and functional limitations. Without proper documentation, it will be denied as cosmetic.

Can CPT 15835 be billed bilaterally with modifier 50?

Yes, CPT 15835 can be billed bilaterally using modifier 50 when the procedure is performed on both buttocks during the same operative session. Bilateral billing increases reimbursement to 150% of the base rate ($1,372.62). However, verify payer-specific policies as some require two line items with LT/RT modifiers instead of modifier 50.

What documentation is required for CPT 15835 medical necessity?

Required documentation includes: weight loss history (50+ pounds) with 12-18 months stability, photographs showing excess tissue and complications, evidence of functional impairment or recurrent infections, 3-6 months of failed conservative treatments, current BMI typically <32, dermatology records if applicable, and operative report detailing tissue weight and closure technique. Psychological clearance may be required for post-bariatric patients.

Can CPT 15835 be billed with panniculectomy code 15830?

CPT 15835 and 15830 are subject to NCCI edits and typically cannot be billed together unless they involve distinct anatomical sites with separate incisions. Modifier 59 may be appropriate if the procedures are truly distinct and non-overlapping, but documentation must clearly demonstrate separate surgical fields. Improper unbundling will result in denial of one or both codes.

How many RVUs is CPT code 15835 worth in 2025?

CPT 15835 has a total RVU value of 28.29 in 2025, consisting of 12.99 work RVUs, 12.92 practice expense RVUs (both facility and non-facility), and 2.38 malpractice RVUs. This relatively high RVU value reflects the complexity and time required for the procedure.

What is the global period for CPT 15835?

CPT 15835 has a 90-day global surgical period. This means that all related pre-operative and post-operative care within 90 days of the procedure is included in the reimbursement and should not be billed separately. Unrelated E/M services during this period require modifier 24, and complications requiring return to OR require modifier 78.